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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 12/04/2023 <br />To: San Joaquin County <br />Department of Public Works <br />AT&T CALIFORNIA -VALLEY PERMIT DESK <br />(Applicant Name) <br />1445 Van Ness Ave <br />(Mailing Address) <br />Fresno, CA 93721 <br />(City, State, Zip Code) <br />285-4894 g26977@att.com <br />(Area Code - Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP.DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT FOR <br />AT&T JOB# A02EKEJ; <br />SEE ATTACHMENTS <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the EAST side of NAGLEE RD approximately 167 ee mile NORTH <br />of AUTO PLAZA DR , by performing the following work (-description of work): <br />21530 NAGLEE RD -AERIAL CABLE PLACEMENT INVOLVING (33)POLES WITH AERIAL STREET <br />CROSSINGS OVER NAGLEE RD & W MIDDLE RD. ACCESS FOREIGN OWNED SPLICEBOX <br />Work will commence on or about 1/29.2024 <br />for approximately 10 DAYS <br />days. <br />I, the undersigned, certify that I am the owner of the respective property, or am qualified to represent the owner and agree to do the <br />work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />L3�'La�v � Sc�u�lclt� <br />Signature of Applicant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />12/04/2024 <br />Date <br />